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Targeting the stress response in pediatric pain: current evidence for psychosocial intervention and avenues for future investigation

Nonpharmacological treatments for chronic pain in youth have been identified as first-line treatments over and above medication. Therapies such as cognitive-behavioral therapy and mindfulness-based stress reduction have shown good efficacy in reducing the psychological correlates (eg, anxiety, depre...

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Autores principales: Nelson, Sarah, Borsook, David, Bosquet Enlow, Michelle
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8423392/
https://www.ncbi.nlm.nih.gov/pubmed/34514276
http://dx.doi.org/10.1097/PR9.0000000000000953
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author Nelson, Sarah
Borsook, David
Bosquet Enlow, Michelle
author_facet Nelson, Sarah
Borsook, David
Bosquet Enlow, Michelle
author_sort Nelson, Sarah
collection PubMed
description Nonpharmacological treatments for chronic pain in youth have been identified as first-line treatments over and above medication. Therapies such as cognitive-behavioral therapy and mindfulness-based stress reduction have shown good efficacy in reducing the psychological correlates (eg, anxiety, depression, and stress) and social or behavioral sequelae (eg, limited physical activity and lack of school engagement) associated with pediatric chronic pain. However, minimal research has examined the physiological mechanism(s) of action for these interventions. A recent review (Cunningham, et al., 2019) emphasized the need for objective (ie, physiological) assessment of treatment response in pediatric pain populations. The current review adds to this literature by identifying the physiological stress response as a particular target of interest in interventions for pediatric pain. Research indicates that youth with chronic pain report high rates of psychological stress, posttraumatic stress symptoms, and exposure to adverse childhood experiences (abuse/neglect, etc). In addition, a host of research has shown strong parallels between the neurobiology of pain processing and the neurobiology of stress exposure in both youth and adults. Interventions such as narrative or exposure therapy (eg, trauma-focused cognitive-behavioral therapy) and mindfulness-based or meditation-based therapies have shown particular promise in alleviating the neurobiological impact that stress and pain can have on the body, including reduction in allostatic load and altered connectivity in multiple brain regions. However, no study to date has specifically looked at these factors in the context of pediatric pain treatment. Future research should further explore these constructs to optimize prevention in and treatment of these vulnerable populations.
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spelling pubmed-84233922021-09-09 Targeting the stress response in pediatric pain: current evidence for psychosocial intervention and avenues for future investigation Nelson, Sarah Borsook, David Bosquet Enlow, Michelle Pain Rep Pediatric Nonpharmacological treatments for chronic pain in youth have been identified as first-line treatments over and above medication. Therapies such as cognitive-behavioral therapy and mindfulness-based stress reduction have shown good efficacy in reducing the psychological correlates (eg, anxiety, depression, and stress) and social or behavioral sequelae (eg, limited physical activity and lack of school engagement) associated with pediatric chronic pain. However, minimal research has examined the physiological mechanism(s) of action for these interventions. A recent review (Cunningham, et al., 2019) emphasized the need for objective (ie, physiological) assessment of treatment response in pediatric pain populations. The current review adds to this literature by identifying the physiological stress response as a particular target of interest in interventions for pediatric pain. Research indicates that youth with chronic pain report high rates of psychological stress, posttraumatic stress symptoms, and exposure to adverse childhood experiences (abuse/neglect, etc). In addition, a host of research has shown strong parallels between the neurobiology of pain processing and the neurobiology of stress exposure in both youth and adults. Interventions such as narrative or exposure therapy (eg, trauma-focused cognitive-behavioral therapy) and mindfulness-based or meditation-based therapies have shown particular promise in alleviating the neurobiological impact that stress and pain can have on the body, including reduction in allostatic load and altered connectivity in multiple brain regions. However, no study to date has specifically looked at these factors in the context of pediatric pain treatment. Future research should further explore these constructs to optimize prevention in and treatment of these vulnerable populations. Wolters Kluwer 2021-09-03 /pmc/articles/PMC8423392/ /pubmed/34514276 http://dx.doi.org/10.1097/PR9.0000000000000953 Text en Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Pediatric
Nelson, Sarah
Borsook, David
Bosquet Enlow, Michelle
Targeting the stress response in pediatric pain: current evidence for psychosocial intervention and avenues for future investigation
title Targeting the stress response in pediatric pain: current evidence for psychosocial intervention and avenues for future investigation
title_full Targeting the stress response in pediatric pain: current evidence for psychosocial intervention and avenues for future investigation
title_fullStr Targeting the stress response in pediatric pain: current evidence for psychosocial intervention and avenues for future investigation
title_full_unstemmed Targeting the stress response in pediatric pain: current evidence for psychosocial intervention and avenues for future investigation
title_short Targeting the stress response in pediatric pain: current evidence for psychosocial intervention and avenues for future investigation
title_sort targeting the stress response in pediatric pain: current evidence for psychosocial intervention and avenues for future investigation
topic Pediatric
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8423392/
https://www.ncbi.nlm.nih.gov/pubmed/34514276
http://dx.doi.org/10.1097/PR9.0000000000000953
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